Every day I cough up what looks like a scab with ugly mucous and blood

Hello @vita61 and welcome to Mayo Clinic Connect. I understand you are frustrated with the lack of understanding from the several doctors you have seen to try to help you better understand why you are getting these re-occurring scabs.

Members like @conniehar @searchingforrelief @dapapa have recently been sharing some tips with one another and might have some additional thoughts to share with you.

Can I ask what, if any, intervention(s) you have tried to either release the scabs or if you mainly rely on coughing? I can imagine that is very hard on your throat and body for as many hours as you described above.

@vita61 I too have seen several several ENTs and a few GPs and none of them have known what it is. The most recent ENT did scope me and said I have irritated adenoids, that perhaps removing them MIGHT help, but not necessarily. I have found a couple of things that sometimes help dislodge the scabby thing: A hot shower, I usually let the water run over my face quite a lot, or eating something like a sandwich or other substantial meal. The worst though is when I become completely fixated on getting it out so I often just try to distract myself...

@searchingforrelief- Hi. What you have going on is not a “scab” it’s dried hard mucous that for some reason does not clear properly in a certain area. The mucous will sit there, become stagnant, grow bacteria and harden. You start to feel it when it’s finally gotten stagnant enough and needs to get out. Do NOT got to an ENT for this. They are surgeons before anything else and do not care, nor take interest unless they can cut parts out of you. They will create a “maybe” story as to why something is happening and it will all be due to your anatomy, which is not the case. If you feel the need to see someone about it, I would work with a Natrual Path, one who takes special interests in the nasal cavity/sinuses. For now, I would increase water intake, Vitamin C, eat an anti inflammatory diet, use nasal irrigation and humidification. ENTs do. It take the time to educate patients on how nasal mucosa actually works. If they did, they would be out of business. Keep your ciliary function (the little hairs that sweep mucous out) properly. Mucosa needs moisture and a good immune system to work effectively. Hope this helps. Because I know ENTs don’t.

Sorry to hear of how bad this is for you. as others here have mentioned moisture seems to help it not get as hard and not get as stuck as it sounds yours gets. As someone else mentioned, anytime i'm in the shower i put a bridge with my hands over my nose so i don't inhale any water but take a few slow good inhales of the steam. also in the mornings i often get one loose when i'm having coffee. again the moist heat seems to make it dislodge more easily. Whenever i do get one that sticks and gets caught, hacking away as you mentioned, if i sit and lean forward while i cough it isn't as likley to get caught in my throat , seems to dislodge quicker. Keep trying different things, i know it's awful but don't let it take away from your life! You are stronger than this little slime in your nose 😉 I have several other health issues that are very difficult to live with everyday but i have to remind myself often that I WON'T let them win. they will not beat my spirit! best wishes to you, 🙂 I hope the moisture ideas give you some relief.

Because so much has been mentioned with regard to keeping moisture and hydration in mind, I am wondering if anyone has tried a facial steamer and/or used a humidifier consistently with any luck?

@searchingforrelief
Depending upon your age, you probably don't have adenoids, but your problem sounds like it's in the same area as mine, which I've previously uploaded picures of the thumbnail sized "scab"

For years I was getting the scab about every 4-6 weeks until I had my deviated septum corrected by a local ENT 2 years ago.
After that I was getting the scabs every 3 days.
I had 2 MRIs and a CAT scan – I have really good insurance, but no indication of what was causing the scab.
At one point I took an antibiotic for 10-days, and the scab went away for 2 months … then it came back, though on a 4-5 day cycle.

I had a scab extracted and sent off to pathology, which came back with “Heavy Growth Staphylococcus Aureus”
After over a year of the local ENT trying to figure out what was going on, he decided to send me to the Specialist at Penn Medicine in Philadelphia – The Dr. you go to see when your local ENT isn’t able to find a solution.

He looked at my scans and history, and said yup I’ve seen this before … which was encouraging.
He said that I have a structural issue with my sinus that would be repairable, but felt that correcting the problem with the growth could be done without surgery.

As @nrd1 pointed out, your ciliary function (the little hairs that sweep mucous out) needs to be properly working. In my case, hydration and moisture helped to dislodge the scab, but did not help the underlying problem, which was a staph colonization causing a biofilm to develop. Note that this is a staph colonization, not a staph infection.

The solution for me was to give my body time to repair itself by breaking down the biofilm over a 21 day period. This gave the underlying tissue a chance to repair the cilia
• Clindamycin for 21 days
• Nasal Rinse twice a day – Distilled water (not tap!), saline, ½ tsp baby shampoo, Mupironcin, Budesonide
• Based on where my scab forms, in the upper nasopharynx where my adenoids would be, I must bend over so that when I rinse with the solution, it actually gets to the spot where the scab forms. I find it most convenient to do this in the morning when I shower. If I don’t bend over, then it’s not getting to the area.

Other notes:
• For the 1/2 Teaspoon of baby shampoo, I measured it at first, now I just squeeze in an approximate amount. It sounds crazy, but J&J Baby shampoo is what breaks down the biofilm -- see picture of the rinse ingrediants. I also warm the rinse before I use it.
• Be sure to rinse the sinus rinse bottle every 2 weeks with 1/3 Hydrogen peroxide 2/3 Distilled water. And never use tap water.

Looking forward to hearing if this works for anyone else. I've a long history with this, so the notes above are an abbreviation that I wanted to quickly pass on to you and the others in this forum.

Be well 🙂

@jfvero Thank you for sharing this concrete info, I will try what I can in my own and share it with my doctor. Really great that you were able to have your scab analyzed! I am 55 and had a rhinoplasty to correct a deviated septum 30 years ago. The goal was to improve breathing on my left side but it didn’t help and in fact over the decades my issues have gotten worse, leading to the blood/mucus clots. I did think it was odd that the ENT I saw a year ago said my adenoids were irritated. I have tried to explain where the clot forms as the spot where the nasal/sinus passage meets the throat. Do you know exactly where yours was located?

@searchingforrelief @jfvero - yes it is all about the ciliary function and clearance. We all have Staph A in our nasal mucosa and skin. It normally does not cause an issue. Unless it stays in one spot and does not flow out. People who have had any type of nasal/sinus surgery will have disruption to their nasal mucosa/ciliary function. Especially a septal deviation surgery as the septum is formed in a way (deviated or not) that provides an airflow that gives proper humidification and resistance to the nasal mucosa and ciliary function. It actually takes away your natural humidification when you “fix” a deviated septum, because you are exposing the nasal cavity to more forced air. One of the risks, ENTs don’t warn about from nasal surgery is “dryness”. It’s much more than a simple dryness, however as that dryness is mucosal impairment. Something that might be a little annoying, is nothing that should have altered anatomy over. In the ENT community it is known that dry air is the, in their words is “death of ciliary” function. So why they would perform surgeries that expose the nasal cavity to more air that can not be properly humidified is beyond me. In saying that- just know there are many things that take place within the nasal cavity that you have control over, through diet, rest, and overall an effort into total health.
You have to get to the root cause. And the answer does not lie in manipulation and cutting of the tissue.

Thank you again. Your posts are so helpful!

My scab is located where my adenoids would be – in the way back where the sinus meets up with the throat (my layman’s terms). If you look at the image I uploaded, you can see it in the picture. It’s the location for me that causes the need to bend over to reach hitting it with the nasal rinse. If I just do a regular rinse, it misses the spot.
Initially my local ENT looked for the spot with a stiff scope but said he didn't see anything. It wasn't until I coughed one of these up in the office that he pulled out the flexible scope and looked way in the back and saw the area.
also -- I'm 59, and had the deviated septum repaid 2 years ago. It was a result of a football injury from my childhood, and I was never able to breath properly through my nose.